Inova – Fast 50 2003


Inova Fairfax Hospital was ground zero for the anthrax crisis. When two postal workers entered the emergency room, physicians suspected anthrax. The challenge was to save them both and to develop an effective new protocol for the little-seen disease. The Inova team made groundbreaking contributions to the treatment protocol by adding clarity to screening guidelines, demonstrating the effectiveness of certain antibiotics, identifying potential complications–and, most important, successfully treating both patients.


The Inova health-care team
Inova Health System
Springfield, Virginia

Additional Team Members:
Cecele E. Murphy, MD, Emergency Medicine; Leroy Richmond, anthrax survivor,
J. Knox Singleton, President and Chief Executive Officer Inova Health System,
Richard M Knapp, Chairman, Inova Health System Board of Trustees.


Tell us what you do (or what your team or organization does) and the specific challenge you faced.
Inova Fairfax Hospital is a tertiary care facility and a Top 100 Hospital nationally serving the greater Washington, DC region. When anthrax-laced letters appeared in the mail in October 2001, the CDC believed postal workers weren’t at risk. But two patients came to the hospital’s emergency department complaining of unusual symptoms. Alert physicians noted that both worked in the postal facility that handled mail sent to the U.S. Capitol. Physicians suspected these patients might have anthrax. The challenge was to save these Patients, despite anthrax’s 85 percent mortality rate, and develop an effective new treatment protocol for a little-known disease.

What was your moment of truth?
Inova’s medical team was in uncharted territory. It took many correct decisions by the right people in record time to defy the odds. There were several simultaneous moments of truth: Trust your intuition. When in doubt, treat the case as though it were anthrax. Anthrax is very difficult to diagnose so physicians ordered CT scans, which showed enlarged lymph nodes in the chest. They also ordered PCR testing to confirm the diagnosis. Most importantly, they initiated antibiotic treatment immediately. Expect the unexpected. Each case took surprising twists. When the CDC confirmed the diagnoses, two additional antibiotics were added to supplement the fight. Medical specialists monitored both patients closely, managing complications as they arose. It takes teamwork. Inova Fairfax Hospital’s emergency medicine, radiology and pathology specialists quickly evaluated and began treatment. An infectious disease physician from the patients’ HMO helped Inova’s specialists manage care. Hospital and marketing communications staff coordinated communication internally to employees and externally to other hospitals and the community. Inova collaborated with the CDC, U.S. Postal Service and Fairfax County Health Department. Focus on the positive. Every step of the way, the team believed it could save these patients’ lives and worked around the clock to do it. (The exact date? 10/19/2001)

What were the results?
Through teamwork, skill and knowledge, Inova defied the conventional wisdom about anthrax. Both patients survived and remain anthrax-free. As a Wall Street Journal headline stated in November 2001: “Anthrax Victims’ Fate Varied by What Hospital, Which Doctor They Saw.” Inova made important medical contributions about anthrax, adding definition to the clinical work-up, stipulating early intervention with specific antibiotics, and identifying potential complications. The Journal of the American Medical Association deemed this information so valuable it waived its usual waiting period and published the results in November 2001, faster than any other article in JAMA history.


What’s your parting tip?
Be prepared for the unthinkable. There’s no substitute for readiness in the face of unknown enemies.

Read more entries from the Fast 50 2003